Healthcare Provider Details

I. General information

NPI: 1972987964
Provider Name (Legal Business Name): DR. AHMED ELSAYED SHADY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE SUITE#706
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

1901 1ST AVE SUITE#706
NEW YORK NY
10029-7404
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6771
  • Fax:
Mailing address:
  • Phone: 212-423-6771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301511813
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: